DOAC

Perioperative bleeding risk does not appear to differ among DOAC medications

predictable PK & PD

peak effects occurring 2 to 3 hours after DOAC intake

Elimination half-lives of factor Xa inhibitors (apixaban, rivaroxaban, andedoxaban) are 8 - 12h in patients with a CrCl above 30mL/min.

Dabigatran

higher dependence on kidney clearance
Elimination half life
- CrCl >50ml/min → 10 - 14h
- CrCl 30-49.9ml/min → 18 - 24h

because the typical length of DOAC cessation perioperatively is short (eg, 2-4 days), the risk of thromboembolism associated with DOAC cessation in the perioperative period is low (eg, <0.5%)

DOACs are not recommended for use in pregnant or breastfeeding individuals becausetheycrosstheplacentaandarepresentinbreast milkandthere are insufficient data about their safety for the fetus andnewborn

References

Perioperative Management of Patients Taking Direct Oral Anticoagulants - A Review - JAMA